Early intervention in youth mental health: development of guidelines for general practice

Aims: GPs, as healthcare professionals with whom young people commonly interact, have a central role in early intervention for youth mental health. To support GPs in this important role, we aim to develop clinical guidelines to promote identification and treatment of mental and substance use disorders among young adults (age 16-24). Methods: Following a qualitative study of young people and healthcare professionals in two urban deprived areas, we conducted a modified Delphi study using the following steps: i) Established an Expert Panel involving 18 key stakeholders; ii) Identified key areas which the guidelines should address using a group meeting and survey; iii) Reviewed and synthesised relevant literature; iv) Review of items created again by the stakeholder panel, with another meeting and survey. Results: Twenty-two items were considered important for inclusion in the guidelines and 17 items important for implementing them. These items could be divided into five different domains 1. Prevention, Health Promotion and Access; 2. Assessment and Identification; 3. Interaction with Other Agencies/Referral; 4. Ongoing Support; and 5. Implementation issues. Conclusions: Guidelines which would include all 22 items and 17 implementations would be too unwieldy for reasonable use by GPs. However, once split into the different domains, followed by further literature synthesis and review from the expert panel, it is hoped guidelines more applicable and feasible for use in practice will be created under these headings

Youth mental health in deprived urban areas: A Delphi study on the role of the GP in early intervention.

For table 1-4, box 1-2 & figure 1 relating to this article please see attached files.Background: GPs, as healthcare professionals with whom young people commonly interact, have a central role in early intervention for mental health problems. However, successfully fulfilling this role is a challenge, and this is especially in deprived urban areas. Aims: To inform a complex intervention to support GPs in this important role, we aim to identify the key areas in which general practice can help address youth mental health and strategies to enhance implementation. Methods: We conducted a modified Delphi study which involved establishing an expert panel involving key stakeholders / service providers at two deprived urban areas. The group reviewed emerging literature on the topic at a series of meetings and consensus was facilitated by iterative surveys. Results: We identified 20 individual roles in which GPs could help address youth mental health address youth mental health, across five domains: 1. Prevention, Health Promotion and Access, 2. Assessment and Identification, 3. Treatment Strategies, 4.Interaction with Other Agencies/Referral, and 5. Ongoing Support. With regard to strategies to enhance implementation, we identified a further 19 interventions, across five domains: 1.Training, 2. Consultation Improvements, 3. Service-Level Changes, 4. Collaboration, and 5.Healthcare-system Changes. Conclusions: GPs have a key role in addressing youth mental health and this study highlights the key domains of this role and the key components of a complex intervention to support this role

Youth mental health in deprived urban areas: A Delphi study on the role of the GP in early intervention.

Background: GPs, as healthcare professionals with whom young people commonly interact, have a central role in early intervention for mental health problems. However, successfully fulfilling this role is a challenge, and this is especially in deprived urban areas. Aims: To inform a complex intervention to support GPs in this important role, we aim to identify the key areas in which general practice can help address youth mental health and strategies to enhance implementation. Methods: We conducted a modified Delphi study which involved establishing an expert panel involving key stakeholders / service providers at two deprived urban areas. The group reviewed emerging literature on the topic at a series of meetings and consensus was facilitated by iterative surveys. Results: We identified 20 individual roles in which GPs could help address youth mental health address youth mental health, across five domains: 1. Prevention, Health Promotion and Access, 2. Assessment and Identification, 3. Treatment Strategies, 4.Interaction with Other Agencies/Referral, and 5. Ongoing Support. With regard to strategies to enhance implementation, we identified a further 19 interventions, across five domains: 1.Training, 2. Consultation Improvements, 3. Service-Level Changes, 4. Collaboration, and 5.Healthcare-system Changes. Conclusions: GPs have a key role in addressing youth mental health and this study highlights the key domains of this role and the key components of a complex intervention to support this role

"Nobody really gets it”: A qualitative exploration of youth mental health in deprived urban areas

Aim: To explore and describe the experience of mental health and addiction for young people living in urban deprived areas in Ireland. Method: Semi-structured qualitative interviews were conducted with 20 young adults attending health and social care agencies in two deprived urban areas, and analysed using thematic analysis. Results: Five main themes were identified: experiencing symptoms, symptom progression, delay accessing help, loss of control/crisis point, and consequences of mental health and substance use issues. As young people delayed help, symptoms disrupted normal life progression and they found themselves unable to engage in every-day activities. Living in deprivation made it harder to avoid developing problems: many had added stressors, less familial support and early exposure to violence, addiction and bereavement. Conclusion: Young people in urban deprived areas are vulnerable to mental health and addiction issues. Early identification is necessary to halt this progression to improve their chances of achieving their potential

Development and evaluation of an educational intervention in youth mental health for primary care practitioners.

Objectives: Irish adolescents have one of the highest rates of suicide and self-harm in the European Union. Although primary care has been identified as an opportune environment in which to detect and treat mental health problems in adolescents, lack of training among primary care professionals (PCPs) is a barrier to optimum identification and treatment. We describe the development and evaluation of an educational intervention on youth mental health and substance misuse for PCPs. Methods: Thirty general practitioners and other PCPs working in the Mid-West region participated in an educational session on youth-friendly consultations, and identification and treatment of mental ill-health and substance use. Learning objectives were addressed through a presentation, video demonstration, small-group discussions, role play, question-and-answer sessions with clinical experts, and an information pack. Following the session, participants completed an evaluation form assessing knowledge gain and usefulness of different components of the session. Results: 71% of participants were involved in the provision of care to young people. 55% had no previous training in youth mental health or substance abuse. Participants rated knowledge gains as highest with regard to understanding the importance of early intervention, and primary care, in youth mental health. The components rated as most useful were case studies/small group discussion, the ‘question-and-answer session’ with clinical experts, and peer interaction. Conclusions: The educational session outlined in this pilot was feasible and acceptable and may represent an effective way to train professionals to help tackle the current crisis in youth mental health

How social context impacts on the development, identification and treatment of mental and substance use disorders among young people - a qualitative study of health care workers

Introduction: Social context has a major influence on the detection and treatment of youth mental and substance use disorders in deprived urban areas, particularly where gang culture, community violence, normalisation of drug use and repetitive maladaptive family structures prevail. This paper aims to examine how social context influences the development, identification and treatment of youth mental and substance use disorders in deprived urban areas from the perspectives of health care workers. Method: Semi-structured interviews were conducted with health care workers (n=37) from clinical settings including: primary care, secondary care and community agencies and analysed thematically using Bronfenbrenner’s Ecological Theory to guide analysis. Results: Health care workers’ engagement with young people was influenced by the multilevel ecological systems within the individual’s social context which included: the young person’s immediate environment / ‘microsystem’ (e.g. family relationships), personal relationships in the ‘mesosystem’ (e.g. peer and school relationships), external factors in the young person’s local area context / ‘exosystem’ (e.g. drug culture and criminality) and wider societal aspects in the ‘macrosystem’ (e.g. mental health policy, healthcare inequalities and stigma). Conclusions: In deprived urban areas, social context, specifically the micro- meso- exo- and macro-system impact both on the young person’s experience of mental health or substance use problems and services which endeavour to address these problems. Interventions that effectively identify and treat these problems should reflect the additional challenges posed by such settings

Towards early intervention for youth mental health in primary care: a qualitative study of service provider perspectives in two deprived urban areas

Aims: Early intervention in youth mental health is increasingly viewed as easier, cheaper and more effective than traditional approaches to care. GPs, as the healthcare professional most often consulted by young people, have a central role in early detection of youth mental health and addiction disorders. However, international data suggests many young people have concerns bringing these issues to their GP, and GPs themselves experience difficulty identifying and treating mental health issues. The aim of this study is to gain an understanding of the experience of youth mental health and addiction treatment in two deprived urban areas to inform future early intervention practice development. Methods: Semi-structured interviews were recorded with 37 healthcare professionals. Inductive thematic analysis was carried out using QSR NVivo 9. Results: ‘Context’ suggests youth mental health issues are considerably influenced by wider societal context and local factors (e.g. family). Intervention suggests many barriers and enablers to helping young people, be that at the identification, treatment, or engagement stages of intervention. Conclusions: Many factors influence how a young person develops, seeks help for, and engages with treatment for mental and substance use disorders. This knowledge is useful in developing interventions in primary care that are specific to deprived urban areas

Primary care and youth mental health in Ireland:qualitative study in deprived urban areas

Background: Mental disorders account for six of the 20 leading causes of disability worldwide with a very high prevalence of psychiatric morbidity in youth aged 15–24 years. However, healthcare professionals are faced with many challenges in the identification and treatment of mental and substance use disorders in young people (e.g. young people’s unwillingness to seek help from healthcare professionals, lack of training, limited resources etc.) The challenge of youth mental health for primary care is especially evident in urban deprived areas, where rates of and risk factors for mental health problems are especially common. There is an emerging consensus that primary care is well placed to address mental and substance use disorders in young people especially in deprived urban areas. This study aims to describe healthcare professionals’ experience and attitudes towards screening and early intervention for mental and substance use disorders among young people (16–25 years) in primary care in deprived urban settings in Ireland. Methods: The chosen method for this qualitative study was inductive thematic analysis which involved semistructured interviews with 37 healthcare professionals from primary care, secondary care and community agencies at two deprived urban centres. Results: We identified three themes in respect of interventions to increase screening and treatment: (1) Identification is optimised by a range of strategies, including raising awareness, training, more systematic and formalised assessment, and youth-friendly practices (e.g. communication skills, ensuring confidentiality); (2) Treatment is enhanced by closer inter-agency collaboration and training for all healthcare professionals working in primary care; (3) Ongoing engagement is enhanced by motivational work with young people, setting achievable treatment goals, supporting transition between child and adult mental health services and recognising primary care’s longitudinal nature as a key asset in promoting treatment engagement. Conclusions: Especially in deprived areas, primary care is central to early intervention for youth mental health. Identification, treatment and continuing engagement are likely to be enhanced by a range of strategies with young people, healthcare professionals and systems. Further research on youth mental health and primary care, including qualitative accounts of young people’s experience and developing complex interventions that promote early intervention are priorities. (350 words

The role of context in youth mental health and addiction issues: a qualitative study on social deprivation in Limerick City and Dublin South Inner City

Introduction: Youth mental health (YMH) and addiction issues are a core component of the problems facing those living in urban areas of social deprivation in Ireland, in particular South Inner City Dublin and Limerick City 1,2. These local contexts, with histories of drug addiction, violence, family dissolution, suicide and gang-related criminality lend themselves to promote further criminal and addictive behaviour, as well as increased stress and decreased protective factors such as social support and education. Early intervention is considered a ‘best buy’ in mental health, but the current Irish system struggles to engage with young people and offer them appropriate treatment

Towards early intervention for youth mental health in primary care: a qualitative study in two deprived urban areas

Towards early intervention for youth mental health in primary care: a qualitative study in two deprived urban area